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20040962.pdfDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OW;:ky AME/NAME OF BUSINES i LUA P ) fL&k)15- w MAILING ADDRESS 3 0 7 �( CITY NAME Ot It -I ADDRESS CITY NAM ADDRESS e/ ZIP TELEPHONE !4( ZIP TELEPHONE CBL ?t&' x ii:?W46�6 7 TELI EPHONE btATE� LICENSE NUMBER EX P ATION ATE CHECKED BY a PROPERTY TAX nnACCOUNT PARCEL NO. nn ❑ NEW RESIDENTIAL ❑ PLUMBING / MECH ❑ ADDITION COMPLIANCE OR ❑ COMMERCIAL ❑ CHANGE OF USE ❑ REMODEL ❑ MULTIFAMILY ❑ SIGN ❑❑ GRADING CYDS ❑ i FENCE X Fr) REPAIR ❑ DEMOLISH TANK ❑ OTHER GARAGE RETAINING WALL FIRE SPRINKLER z ❑ CARPORT ❑ ROCKERY ❑ FIRE ALARM 0 (TYPE.pF USE, BUSINESS O.� ACTIVfa;� EXPLAIN• r FL 1U w NUMBER NUMBER OF CRITICAL OF DWELLING AREAS O STORIES UNITS NUMBER DESCRIBE WORK TO BE DONE GLAZING % I r LOT SLOPE % PERMIT EXPIRESSE ZONE PERMIT NUMBER JADDRESS C OB q / PLAT NAME/SUBDIVISION NO LOT NO. PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP EXISTING PROPOSED SUITE/APT# LID NO. LID FEE S TESCP Approved ❑ RW Pormit Required ❑ Seem Use Permit RogA ❑ Inspection Required ❑ Sidewalk Required ❑ REQUIRED DEDICATION FT underground Wiring required ❑ METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 17 YES ❑ NO ❑ _ cc REMARKS z z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE Z5 ..i Tr ENGINEERING REVIEWED BY DATE FIRE REVIEWED BY DATE w l VARIANCE OR CU SHORELINE OR ADBH INSPECTION BOND REO'D POSTED OYES ONO S SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SE1 BACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR z z z PARKING LOT AREA PLANNING REVIEWED BY DATE 5 REO'D I PROVIDED REMARKS CHECKED BY ITYP=N, C OCCUPANTJ�; / GROUP 2 SPECIAL INSPECTION JAREA OCCUPANT REQUIRED ❑YES LOAD PLAN CHECK NO: VESTED DATE THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO I. BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE J SEPARATE PERMISSION. Cr PERMIT APPLICATION: 180 DAYS w IL PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION to 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF 2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND 2 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREC TLY OR INDIRECTLY = FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE o DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE 0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' REMARKS t7 PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REQ'D J VALUATION Description �Wmxefi= Building Permit Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Fire Inspection Landscape Insp. Recording Fee I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LADOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION WORKMEN'S ,P,FIMPEN$4TION INSURANCE AND RCW 18 27. DATE JIGNE (425) 't)il I 771 �22U FEE Description FEE State Surcharge �j City Surcharge Base Fee Plan Chk. Deposit Receipt # Total Amt. Due~ Receipt /# 1 253 ss APPLICATION APPROVAL I his application is not a permit until signed by the Building Official or his/her Deputy. and Fees are paid, and receipt is acknowledged in space provided. ICIA�S SIGNATURE DATE RF� - SFD BY - DATE ATTENTib j EXT 1333 IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL 1112 Z" L' INSPECTION HAS BEEN MADE AND APPROVAL ORACERTIFICATE OF OCCU ORIGINAL -FILE YELLOW -INSPECTOR PANCY HAS BEEN GRANTED. UBC109 / IBC 110 / IRC 110. PINK . OWNER GOLD - ASSESSOR 09/03 PRESS HARD =YOU ARE MAKING 4 COPIES 01 O m fJ7 � 0M m0 �❑ O � _M mZ p� DZ r —I O -n n MM O� nr c cmn �Cn Z� :0 -I 2 D Z 2 W O I m r a LLI �..; > o W _.. ca u w 'Ld o ME z °C Lu �-XI'SII1�-1I'U' U�u�L ► 6 Ra M D P v I 0 0 � c L'i 1kv PLOT P LA,M L7AJ� S z 0 m c m m 0 �O On 2 rn m Z p -1 Cz Cl) O-n mm O� r m Coto rn� zr ;l D z 2 0 0 m f ZOVAL R TO: DATE. 1 • • ilk ••"�!�ORO�, 1 �I � • FROM: r FIRE DEPARTMENT DATE t 3 /0 1 ENGINEERING DIVISION DATE PLEASE SIGN PLANNING DIVISION DATE PLEASE SIGN PROJECT S Pa1A )L SITE ADDRESS i 0 v 0 L-' l- 2c ✓r cup 4 � PERMIT # 0 4 - D 6 ADB# DATE INSPECTED l DESCRIPTION OF WORK TO BE INSPECTED LP G TA�J'V� t N 5TLL toy -&-J A field inspection was conducted to determine final compliance with approved plans. Final approval denotes that there are no objections from the above signed Department to the release of PERFORMANCE BONDS and the granting of GRANT FINAL PROTECT APPROVAL *************************************************************************************** GRANT PROJECT APPROVAL WITH CONDITIONS NOTED ❑ Copy of CONDITIONS given to owner/contractor by inspector 1. FAILED FINAL INSPECTION - OUTSTANDING ISSUES ❑ Copy of CORRECTION NOTICE given to owner/contractor by inspector 1. 2. 3. RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL Date ocaprvl.doc.l:temp:bldg:forms 10/O1 z 0 i 0 m om m0 �0 0C _M m Z p-1 Dz r_ -I �C0 O -n "D 2� MM o nr C fm/) �U) m Zr sr z 0) z 0 m FINAL PROJECT APPROVAL FORM TO: DATE: MEMO TO: PERM CO R NATOR, BUILDING DIVISION FROM: FIRE DEPARTMENT DATE i 1[0 l vLeAse •ICN ; ENGINEERING DIVISION DATE . PLEAS[ SIGN PLANNINGDIVISION DATE PIXASH SIGN PROJECT SITE ADDRESS 7 i o `i ©i Y;24 PERMIT # �� r `� 2 - ADB# DATE INSPECTED I I/ Z DESCRIPTION OF WORK TO BE INSPECTED A field inspection was conducted to determine compliance with approved plans. Final approval denotes that there are no objections from the above signed Department to the release of PERFORMANCE BONDS and the granting of GRANT FINAL PROJECT APPROVAL GRANT PROJECT APPROVAL WITH CONDITIONS NOTED ❑ Copy of CONDITIONS given to owner/contractor by inspector 1. FAILED FINAL INSPECTION - OUTSTANDING ISSUES ❑ Copy of CORRECTION NOTICE given to`owner/contractor by inpector I." 3. RE -INSPECTED OUTSTANDING ISSUES- GRANT FINAL PROJECT APPROVAL Date Signature 1: temp:bldg: forms:ocapn•13/25/04 0 n M U5-1 vm m 0 �o o� = rn m Z 0 �q DZ r� in OD mm_ o nr rn 9Cn Qn Z r- 7' m ;U 2 D, z i Cn 0 i7 M I I RECORD OF INSPECTIONS INSPECTOR DATE APPROVED SETBACKS ..................... FOUNDATION: Footing ...................... Wall .......................... Pier/Porch ................. Retaining Wall ........... Slab Insulation .......... PLUMBING: Underground ............. Rough -In ................... Commercial Final ...... HEATING: Gas Test .................... _ % j �.� �T Gas Piping Equipment Commercial Final ....... EXTERIOR SHEATHING NAILING .......................... FRAMING .........I .............. FIRST FLOOR FRAMING.., INSULATION Floor Insulation ......... Wall Insulation ........... Ceiling Insulation ....... SHEETROCK NAILING ... SPECIAL INSPECTION ... MISCELLANEOUS .......... el FINAL APPROVAL FOR OCCUPANCY `'0 1r The Initials MT are Milton Thotlll)SOII, a temporary Contract inspector for the City. O n m —1 wn CM My �O OC 2 M mm z p==I C z D r- --I 2 N Own mm_ O� nr CCn 9 to m Zrnr D -I 2 D -I 2 0) z O WMA rn I r